Provider Demographics
NPI:1730127820
Name:DELAWARE COASTAL ANESTHESIA LLC
Entity type:Organization
Organization Name:DELAWARE COASTAL ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:RELOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-331-4003
Mailing Address - Street 1:PO BOX 785802
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-5802
Mailing Address - Country:US
Mailing Address - Phone:855-709-4535
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:655 S BAY RD
Practice Address - Street 2:STE 5B
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4660
Practice Address - Country:US
Practice Address - Phone:302-678-4688
Practice Address - Fax:302-678-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000028581Medicaid
DEDB7759OtherRAILROAD
DEG01399Medicare PIN